European Journal of Echocardiography Advance Access published online on October 7, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep152
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Right ventricle in pulmonary arterial hypertension: haemodynamics, structural changes, imaging, and proposal of a study protocol aimed to assess remodelling and treatment effects
1 Department of Cardiopulmonary Sciences, University Hospital S Maria della Misericordia, P.le S Maria della Misericordia 15, 33100 Udine, Italy
2 ‘Prof. Dr C.C. Iliescu’ Institute of Cardiovascular Diseases, Bucharest, Romania
3 Royal United Hospital, Bath, UK
4 Department of Cardiology, University Hospital Sart Tilman, Liege, Belgium
5 Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
6 FRCP Department, Royal Free Hospital, London, UK
7 Department of Cardiothoracic and Vascular Sciences, University of Padua, Padua, Italy
8 Chair of Reumatology, Udine University P.le S Maria della Misericordia 15, 33100 Udine, Italy
Received 21 December 2008; accepted after revision 10 September 2009.
* Corresponding author. Tel: +39 0432 554557; fax: +39 0432 482353. E-mail address: lbadan{at}tin.it; badano.luigi{at}aoud.sanita.fvg.it
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Abstract |
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Although right ventricular (RV) failure is the main cause of death in patients with pulmonary arterial hypertension (PAH), there is insufficient data about the effects of PAH treatment on RV geometry and function mainly because the RV assessment has been hampered by its complex crescentic shape, large infundibulum, and its trabecular nature. Echocardiography is a widely available imaging technique particularly suitable for follow-up studies, because of its non-invasive nature, low cost, and lack of ionizing radiation or radioactive agent. Real-time three-dimensional echocardiography (RT3DE) has been shown to be accurate in assessing RV and left ventricular (LV) volumes, stroke volumes, and ejection fractions in comparison with cardiac magnetic resonance imaging. In this review, we describe RV structural and functional changes which occur in patients with PAH and strengths and weaknesses of current non-invasive imaging techniques to assess them. Finally, we describe an ongoing multicentre, prospective observational study involving seven centres expert in treating patients with PAH from four different countries. Investigators will use conventional and advanced echo parameters from RT3DE and speckle-tracking echocardiography to assess the extent of LV and RV remodelling before symptom onset and during pharmacological treatment in patients with PAH. Seventy patients who will survive for at least 1 year will be recruited. All the participating institutions will perform comprehensive standard 2D and Doppler as well as RT3DE examinations with a pre-defined imaging protocol. Measurements will be performed at the core echocardiography laboratory by experienced observers who will be unaware of each patient's treatment assignment and whether the examination was a baseline or a follow-up study. Enrolment duration is expected to be 1 year.
Keywords: Right ventricle; Right ventricular function; Right ventricular remodelling; Speckle tracking; Treatment; Therapy; Echocardiography; Three-dimensional echocardiography; Pulmonary arterial hypertension